Dietary patterns, which reflect the complexity of food preference, lifestyle and socio-economic status, may play a major role in health and longevity. Understanding dietary patterns and their correlates is important to the research of diet and health relationships. In the Shanghai Men's Health Study (SMHS) a total of 61 582 men aged 40–74 were recruited between 2002 and 2006. Their food intake over the previous year was collected using a validated FFQ. Study participants (75·6 %) reported little or no change in meat and vegetable intake in the 5 years prior to recruitment. Using the baseline data of the SMHS, we assessed dietary patterns, as well as their relationship with socio-demographic and lifestyle factors and with prevalence of some chronic diseases. Three major dietary patterns, fruit-, vegetable- and meat-based diets, were identified in our population. Consumption of the fruit diet appeared to be more common among men who were older and more physically active, had higher income, and lower waist-to-hip ratio (WHR), while this diet was less common among manual labourers. The meat- or vegetable-based diets were less common among elderly men and more common among men with higher WHR. Dietary patterns appeared to be associated with the presence of health conditions. In general, subjects with a chronic disease were more likely to have the vegetable-based diet and less likely to have the fruit- or meat-based diets. Future studies of diet and health in this population will need to carefully take into account these potential confounders.